Highlights
-
•Intraoperative TPT insertion did not improve nutritional intake and WGV30
- •WGV60 in TPT was less than that in GT
- •In Grade 2 + 3 subgroup analysis, TPT also had no advantage.
Summary
Background
Congenital diaphragmatic hernia (CDH) is a severe congenital disease. Some CDH infants
suffer from gastro-esophageal reflux disease (GERD), even after surgical correction
of gastric position. A transpyloric tube (TPT) is inserted into CDH patients under
direct observation intraoperatively in some hospitals in Japan to establish early
enteral feeding. This strategy avoids gastric expansion to maintain a better respiratory
condition. However, it is unclear whether the strategy has a secure effect for patient
prognosis. This study aimed to evaluate the effectiveness of intraoperative TPT insertion
on enteral feeding and postoperative weight gain.
Methods
The Japanese CDH Study Group database was used to identify infants with CDH born between
2011 and 2016, who were then divided into two groups: the TPT group and gastric-tube
(GT) group. In the TPT group, infants underwent intraoperative TPT insertion; postoperative
insertion/extraction of TPT was irrelevant to the analysis. Weight growth velocity
(WGV) was calculated using the exponential model. Subgroup analysis was performed
using Kitano’s gastric position classification.
Results
We analyzed 204 infants, of which 99 and 105 were in the TPT and GT groups, respectively.
Enteral nutrition (EN) in the TPT and GT groups was 52 ± 39 and 44 ± 41 kcal/kg/day
(p = 0.17) at age 14 days (EN14), respectively, and 83 ± 40 and 78 ± 45 kcal/kg/day
(p = 0.46) at age 21 days (EN21), respectively. WGV30 (WGV from day 0 to day 30) in
the TPT and GT groups was 2.3 ± 3.0 and 2.8 ± 3.8 g/kg/day (p = 0.30), respectively,
and WGV60 (WGV from day 0 to day 60) was 5.1 ± 2.3 and 6.0 ± 2.5 g/kg/day (p = 0.03),
respectively. In infants with Kitano’s Grade 2 + 3, EN14 in the TPT and GT groups
was 38 ± 35 and 29 ± 35 kcal/kg/day (p = 0.24), respectively, EN21 was 73 ± 40 and
58 ± 45 kcal/kg/day (p = 0.13), respectively, WGV30 was 2.3 ± 3.2 and 2.0 ± 4.3 g/kg/day
(p=0.76), respectively, and WGV60 was 4.6 ± 2.3 and 5.2 ± 2.3 g/kg/day (p= 0.30),
respectively.
Conclusion
Intraoperative TPT insertion did not improve nutritional intake and WGV30. WGV60 in
TPT was less than that in GT. In Grade 2 + 3 subgroup analysis, TPT also had no advantage.
We could not recommend routine TPT insertion at surgery.
Level of Evidence
III.
Keywords
Abbreviations:
BW (birth weight), CDH (congenital diaphragmatic hernia), EN (enteral nutrition), EQ (energy quantity), GA (gestational age), GERD (gastro-esophageal reflux disease), GT (gastric tube), o/e LHR (observed/expected lung area to head circumference ratio), PN (parenteral nutrition), SD (standard deviation), TPT (transpyloric tube), WGV (weight growth velocity)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
March 5,
2023
Received in revised form:
February 16,
2023
Received:
November 1,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
